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Kusudo K, Uchida H, Okada Y, Yoshida K. Relapse of Tardive Dyskinesia Following Successful Treatment With Amantadine: A Case Report. J Clin Psychopharmacol 2024:00004714-990000000-00224. [PMID: 38497680 DOI: 10.1097/jcp.0000000000001852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
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Pavăl D, Gherghel-Pavăl N, Căpățînă OO, Stan A, Micluția IV. The relevance of anti-N-methyl-D-aspartate receptor encephalitis for psychiatrists. Int J Psychiatry Clin Pract 2024; 28:73-81. [PMID: 38702981 DOI: 10.1080/13651501.2024.2323926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/20/2024] [Indexed: 05/06/2024]
Abstract
Psychiatrists are often the first to be consulted in patients with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. While this disease is rare, psychiatrists need to be aware of its relevant fundamental, clinical and therapeutic aspects. We begin by reviewing the connection between anti-NMDAR encephalitis and the glutamate hypothesis of schizophrenia. Next, we focus on the profile of the patient typically afflicted with this disease. Then, we tackle the limited utility of current diagnostic criteria during the early stage of the disease. After reviewing the psychiatric features, we debate the quest for finding specific psychiatric phenotypes that could facilitate early-stage diagnosis. We conclude by discussing the treatment of psychiatric symptoms and disease outcomes. As follows, this paper presents the relevance of anti-NMDAR encephalitis for psychiatrists.
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Affiliation(s)
- Denis Pavăl
- Department of Psychiatry, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Romanian Association for Autoimmune Encephalitis, Cluj-Napoca, Romania
| | | | - Octavia Oana Căpățînă
- Department of Psychiatry, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Romanian Association for Autoimmune Encephalitis, Cluj-Napoca, Romania
| | - Adina Stan
- Department of Neurology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ioana Valentina Micluția
- Department of Psychiatry, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Hainmueller T, Lewis L, Furer T. Case report: Anti N-methyl-D-aspartate autoimmune encephalitis following a mildly symptomatic COVID-19 infection in an adolescent male. Front Psychiatry 2023; 14:1270572. [PMID: 38111616 PMCID: PMC10725953 DOI: 10.3389/fpsyt.2023.1270572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/30/2023] [Indexed: 12/20/2023] Open
Abstract
Background Antibodies against N-methyl-D-aspartate receptors are the most commonly identified cause of autoimmune encephalitis. While predominantly associated with malignancies, cases of anti-N-methyl-D-aspartate receptor autoimmune encephalitis have been reported after infections with the herpes-simplex virus or, more recently, in patients with severe COVID-19 disease. Case presentation A previously healthy 17-year-old male adolescent acutely developed psychosis with auditory and visual hallucinations, fluctuating mental status, and an isolated seizure 5 weeks after a mildly symptomatic COVID-19 infection. The symptoms continued to worsen, accompanied by catatonia, and additional neurological symptoms developed during the initial antipsychotic treatment. A diagnostic workup revealed antibodies against N-methyl-D-aspartate receptors in the cerebrospinal fluid without other major abnormalities. After establishing the diagnosis, initiation of immunomodulatory therapy stopped the symptom progression and led to full recovery within 2 months. Conclusion The case is remarkable in that anti-N-methyl-D-aspartate receptor autoimmune encephalitis developed shortly after a COVID-19 infection in an adolescent, despite the individual experiencing only mild COVID symptoms. The diagnosis should be considered in cases of acute-onset psychotic symptoms during or after COVID-19 infection, particularly in individuals without a prior psychiatric history, who present with atypical psychiatric or neurological features.
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Affiliation(s)
- Thomas Hainmueller
- Department of Psychiatry, New York University Langone Medical Center, New York, NY, United States
| | - Lambert Lewis
- Department of Psychiatry, New York University Langone Medical Center, New York, NY, United States
- Department of Child and Adolescent Psychiatry, Child Study Center at Hassenfeld Children's Hospital of New York at NYU Langone, New York, NY, United States
| | - Tzvi Furer
- Department of Psychiatry, New York University Langone Medical Center, New York, NY, United States
- Department of Child and Adolescent Psychiatry, Child Study Center at Hassenfeld Children's Hospital of New York at NYU Langone, New York, NY, United States
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Calva-González M, Tello-Gerez TJ, Serrano-Arias F, Cano-Nigenda V, Ramírez-Bermúdez J. The Neuropsychiatric Side of Cerebral Venous Thrombosis: A Case of Delirium and Catatonia. J Psychiatr Pract 2023; 29:493-498. [PMID: 37948175 DOI: 10.1097/pra.0000000000000746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
We report a patient with cerebral venous thrombosis who initially presented with psychosis and who then progressed to delirium and catatonia within a few days. Upon treatment and resolution of the thrombosis, she presented complete remission of the psychiatric disturbances. This case highlights a specific neuropsychiatric presentation of cerebral venous thrombosis involving psychosis, catatonia, and delirium, which, to our best knowledge, has not been reported in the neurological or psychiatric literature. However, it reminds us of mental status and behavioral abnormalities which are not infrequent features of cerebral venous thrombosis. This leads to a discussion regarding the psychopathology, etiology, and pathophysiology of the case.
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Francis A, Mormando C. Catatonia and its varieties: an update. World Psychiatry 2023; 22:476-477. [PMID: 37713559 PMCID: PMC10503915 DOI: 10.1002/wps.21119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/17/2023] Open
Affiliation(s)
- Andrew Francis
- Department of Psychiatry, Penn State Medical School, Hershey, PA, USA
| | - Charles Mormando
- Department of Psychiatry, Penn State Medical School, Hershey, PA, USA
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Tellez-Martinez A, Restrepo-Martinez M, Espinola-Nadurille M, Martinez-Angeles V, Martínez-Carrillo F, Easton A, Pollak T, Ramirez-Bermudez J. Suicidal Thoughts and Behaviors in Anti-NMDA Receptor Encephalitis: Psychopathological Features and Clinical Outcomes. J Neuropsychiatry Clin Neurosci 2023; 35:368-373. [PMID: 37151035 DOI: 10.1176/appi.neuropsych.20220200] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
OBJECTIVE A wide variety of neuropsychiatric symptoms are described during the acute phase of anti-N-methyl-d-aspartate receptor encephalitis (ANMDARE), including psychosis, mania, depression, and catatonia, but there are few reports on suicidal thought and behaviors in ANMDARE. To address this gap in the literature, the authors measured the presence of suicidal thoughts and behaviors among a large cohort of Mexican patients diagnosed with definite ANMDARE. METHODS This observational and longitudinal study included patients with definite ANMDARE hospitalized at the National Institute of Neurology and Neurosurgery of Mexico between 2014 and 2021. Suicidal thoughts and behaviors were assessed before and after treatment by means of a clinical interview with relatives and a direct clinical assessment with each patient. Thoughts of engaging in suicide-related behavior and acts of suicidal and nonsuicidal self-directed violence before and during hospitalization were recorded. RESULTS From a total sample of 120 patients who fulfilled the diagnostic criteria for definite ANMDARE, 15 patients (13%) had suicidal thoughts and behaviors during the acute phase of the disease. All 15 of these patients experienced psychosis and had suicidal ideation with intention. Three patients engaged in preparatory behaviors and seven carried out suicidal self-directed violence. Psychotic depression and impulsivity were more frequent among those patients with suicidal thoughts and behaviors than among those without any form of suicidality. Four patients engaged in self-directed violence during hospitalization. Remission was sustained in 14 of 15 patients, with suicidal ideation and self-directed violence persisting during follow-up in only one patient. CONCLUSIONS Suicidal thoughts and behaviors are not uncommon during the acute phase of ANMDARE. On the basis of our sample, the persistence of these features after immunotherapy is rare but may be observed. A targeted assessment of suicidal risk should be strongly considered in this population.
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Affiliation(s)
- Alberto Tellez-Martinez
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery of Mexico (Tellez-Martinez, Restrepo-Martinez, Espinola-Nadurille, Martinez-Angeles, Martínez-Carrillo, Ramirez-Bermudez); Encephalitis Society, Malton, and Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom (Easton); Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London (Pollak)
| | - Miguel Restrepo-Martinez
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery of Mexico (Tellez-Martinez, Restrepo-Martinez, Espinola-Nadurille, Martinez-Angeles, Martínez-Carrillo, Ramirez-Bermudez); Encephalitis Society, Malton, and Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom (Easton); Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London (Pollak)
| | - Mariana Espinola-Nadurille
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery of Mexico (Tellez-Martinez, Restrepo-Martinez, Espinola-Nadurille, Martinez-Angeles, Martínez-Carrillo, Ramirez-Bermudez); Encephalitis Society, Malton, and Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom (Easton); Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London (Pollak)
| | - Victoria Martinez-Angeles
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery of Mexico (Tellez-Martinez, Restrepo-Martinez, Espinola-Nadurille, Martinez-Angeles, Martínez-Carrillo, Ramirez-Bermudez); Encephalitis Society, Malton, and Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom (Easton); Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London (Pollak)
| | - Francisco Martínez-Carrillo
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery of Mexico (Tellez-Martinez, Restrepo-Martinez, Espinola-Nadurille, Martinez-Angeles, Martínez-Carrillo, Ramirez-Bermudez); Encephalitis Society, Malton, and Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom (Easton); Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London (Pollak)
| | - Ava Easton
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery of Mexico (Tellez-Martinez, Restrepo-Martinez, Espinola-Nadurille, Martinez-Angeles, Martínez-Carrillo, Ramirez-Bermudez); Encephalitis Society, Malton, and Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom (Easton); Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London (Pollak)
| | - Thomas Pollak
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery of Mexico (Tellez-Martinez, Restrepo-Martinez, Espinola-Nadurille, Martinez-Angeles, Martínez-Carrillo, Ramirez-Bermudez); Encephalitis Society, Malton, and Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom (Easton); Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London (Pollak)
| | - Jesus Ramirez-Bermudez
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery of Mexico (Tellez-Martinez, Restrepo-Martinez, Espinola-Nadurille, Martinez-Angeles, Martínez-Carrillo, Ramirez-Bermudez); Encephalitis Society, Malton, and Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom (Easton); Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London (Pollak)
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Jia Y, Li M, Hu S, Leng H, Yang X, Xue Q, Zhang M, Wang H, Huang Z, Wang H, Ye J, Liu A, Wang Y. Psychiatric features in NMDAR and LGI1 antibody-associated autoimmune encephalitis. Eur Arch Psychiatry Clin Neurosci 2023:10.1007/s00406-023-01606-w. [PMID: 37029805 DOI: 10.1007/s00406-023-01606-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 03/29/2023] [Indexed: 04/09/2023]
Abstract
Patients with autoimmune encephalitis (AE) often developed psychiatric features during the disease course. Many studies focused on the psychiatric characteristic in anti-NMDAR encephalitis (NMDAR-E), but anti-LGI1 encephalitis (LGI1-E) had received less attention regarding the analysis of psychiatric features, and no study compared psychiatric characteristic between these two groups. The clinical data of AE patients (62 NMDAR-E and 20 LGI1-E) who developed psychiatric symptoms were analyzed in this study. In NMDAR-E, the most common higher-level feature was "behavior changes" (60/62, 96.8%) and the lower-level feature "incoherent speech" was observed in 33 patients (33/62, 53.2%), followed by "agitation" (29/62, 46.8%) and "incongruent laughter/crying" (20/62, 32.3%). Similar to NMDAR-E, "behavior changes" was most common in LGI1-E (17/20, 85.0%), but the features of suicidality, eating, and obsessive-compulsive were not reported. The top three lower-level features were visual hallucinations (9/20, 45.0%), incoherent speech (8/20, 40.0%), and mood instability (7/20, 35.0%). The comparative study found that "incongruent laughter/crying", in lower-level features, was more frequently observed in NMDAR-E (32.3% vs. 0%, p = 0.002). Moreover, the Bush Francis Catatonia Rating Scale (BFCRS) assessing the catatonic symptoms in NMDAR-E were higher than LGI1-E, but the 18 item-Brief Psychiatric Rating Scale (BPRS-18) showed no difference in the two groups. In summary, both NMDAR-E and LGI1-E often developed psychiatric symptoms. In contrast with LGI1-E, the psychiatric feature "incongruent laughter/crying" was more frequently associated with NMDAR-E, and catatonic symptoms were more severe in NMDAR-E.
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Affiliation(s)
- Yu Jia
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 ChangChun Street, XiCheng District, Beijing, 100053, China
| | - Mingyu Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 ChangChun Street, XiCheng District, Beijing, 100053, China
| | - Shimin Hu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 ChangChun Street, XiCheng District, Beijing, 100053, China
| | - Haixia Leng
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 ChangChun Street, XiCheng District, Beijing, 100053, China
| | - Xiaotong Yang
- Department of Neurology, Youanmen Hospital, Fengtai, Beijing, China
| | - Qing Xue
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 ChangChun Street, XiCheng District, Beijing, 100053, China
| | - Mengyao Zhang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 ChangChun Street, XiCheng District, Beijing, 100053, China
| | - Huifang Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 ChangChun Street, XiCheng District, Beijing, 100053, China
| | - Zhaoyang Huang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 ChangChun Street, XiCheng District, Beijing, 100053, China
- Beijing Key Laboratory of Neuromodulation, Capital Medical University, Beijing, China
- Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Ministry of Science and Technology, Beijing, China
- Institute of Sleep and Consciousness Disorders, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China
| | - Hongxing Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 ChangChun Street, XiCheng District, Beijing, 100053, China
| | - Jing Ye
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 ChangChun Street, XiCheng District, Beijing, 100053, China
- Beijing Key Laboratory of Neuromodulation, Capital Medical University, Beijing, China
- Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Ministry of Science and Technology, Beijing, China
| | - Aihua Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 ChangChun Street, XiCheng District, Beijing, 100053, China
- Beijing Key Laboratory of Neuromodulation, Capital Medical University, Beijing, China
- Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Ministry of Science and Technology, Beijing, China
| | - Yuping Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 ChangChun Street, XiCheng District, Beijing, 100053, China.
- Beijing Key Laboratory of Neuromodulation, Capital Medical University, Beijing, China.
- Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Ministry of Science and Technology, Beijing, China.
- Institute of Sleep and Consciousness Disorders, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China.
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Hansen N. NMDAR autoantibodies in psychiatric disease - An immunopsychiatric continuum and potential predisposition for disease pathogenesis. J Transl Autoimmun 2022; 5:100165. [PMID: 36176328 PMCID: PMC9513762 DOI: 10.1016/j.jtauto.2022.100165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Niels Hansen
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
- Translational Psychoneuroscience, University Medical Center Göttingen, Göttingen, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany.
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